MedHum Monday: Vaccines and History

Okay, it isn’t Monday. It’s Fat Tuesday. But I was a bit waylaid by flu…and that has me thinking about a piece I wrote recently for the Dittrick Museum’s blog on epidemics and vaccines through history. Granted, flu isn’t plague. But it kills large numbers of people annually, even so. (The traditional number had been 36,000 yearly, but the CDC estimates say that the death toll ranges from 3,300 to 49,000 depending on outbreak year– read more).

So today I am re-posting part of that earlier piece, titled “Deadly Effects: Epidemics, Vaccines, and the Measles Outbreak.” If you would like to read the entire article, do check out the Dittrick Museum (and its attendant website and instagram). It’s my home away from home, you know.

In 1875, the 243-person death toll from diphtheria comprised 8.2% of all reported deaths. As was typical of the disease, children comprised most of the mortalities. In the 1880s Dr. Joseph O’Dwyer, a Cleveland Ohio native, developed a method of intubating patients (inserting a tube to keep the airway open) to survive the life-threatening phase of diphtheria. Otherwise, the diphtheria infection slowly closed the throat, and children suffocated to death. [Dittrick Museum, hall exhibit. Read more.]

In 1898, Cleveland witnessed a minor outbreak of of the worlds most dreaded diseases: smallpox. Only a year later, the cases jump from 70 to 475, six times the rate of outbreak. In 1900, the numbers double again to 993–and then, in the plague years of 1901 and 1902, more than 1200 people become ill, with over 200 dying at the height of the disaster. Many of these were children. Those who survived the epidemic were left with horrendous scarring, the “pocks” that welted on the skin left their mark for a lifetime. [Dittrick museum, hall exhibit. Read more.]

In the 20th century, one of the most feared childhood disorders not only killed, but crippled. Poliomyelitis killed more than 6000 people in the US in 1916 [2]; most were under the age of 14. Parents lived in fear; no one–not even President FDR–was safe. An early attempt at vaccine creation proved unsuccessful, and the disease continued. By 1952, 57,628 polio cases were reported in the United States, 21,000 of them paralytic cases.[2]

In each of these epidemics, the victims were largely children–but also those with weakened immune systems, the elderly, the ill. The diseases attacked the powerless, who expired or were crippled under the horrifies gaze of their loved ones. And for much of history, no cure availed itself. But cures did come, in the form of vaccines. And strangely, the key to polio had been found be a man searching in desperation for a cure for measles.

Measles and Milestones

Measles does not, perhaps, sound as terrifying as small pox and polio. However, this highly contagious disease had a much higher mortality rate. Affected children were contagious both before and after the appearance of measles, and worse–it could survive in the air for over an hour just waiting for the next victim. [3] Children got diarrhea and vomited, had a vivid red rash and watery eyes. It hospitalized an average of 48,000 Americans each year through the 1960s, leaving the survivors compromised sometimes with brain damage or deafness. With over 4000 cases of encephalitis, many children became wards of the state. [2] In other, poorer, countries, millions died every year. Alexander Langmuir, chief CDC epidemiologist in 1961, stated emphatically: “Any parent who has seen his small child suffer even for a few days with a persistent fever of 105, hacking cough and delirium, wants to see this disease prevented.” [3]

At the same time, it was important for Langmuir that the vaccines be safe. In 1935, Maurice Brodie and John Kolmer tested a polio vaccine that proved disastrous and even deadly. It would be 1952 before the next serious trial, the successful Salk and Sabine vaccines. John Enders, who found the key to polio while looking for a measles cure, created a vaccine of mild measles that was added to other boosters children received for the diseases mentioned above. At last, children could be better protected and parents need not fear the daycare centers or play dates, school yards or other common grounds that had harbored these diseases. [3]

That does not mean, of course, that vaccines were unproblematic. The first disease to yield a vaccine was, in fact, smallpox. Edward Jenner injected a milder version, that of cowpox, into a healthy child. The act of risk and daring would be considered highly unethical today–but again, small pox killed and maimed many in the 18th century. The treatment worked. For polio, the earlier trial had resulted in illness and death. A later version, by Albert Sabin, introduced a weakened but still living virus. Jonas Salk’s vaccine worked by stimulating the immune system against polio without giving a live virus. Complications still arose, such as the contamination of both vaccines with SV40 virus at a facility of American Home Products. Even so, the US was polio free by 1979, and the crippling, painful, deadly disease no longer threatened American children. Measles, mumps, rubella, smallpox, polio, and diphtheria–despite setbacks, US parents, spurred by public action and social responsibility as well as the need to protect their own children, flocked to immunization centers. The understanding: we aren’t protected until we are *all* protected.

Lucas, William Palmer, 1880-1961. Experiments as to the protective value of certain specific sera and vaccines against the virus of poliomyelitis / by William P. Lucas and Robert B. Osgood. Boston, Mass. : Wright & Potter Printing Co., State Printers … , 1912

Kirkpatrick, J. (James), approximately 1696-1770. The analysis of inoculation: comprising the history, theory, and practice of it: with an occasional consideration of the most remarkable appearances in the small pocks. London, J. Buckland [etc.] 1761